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Please print or type.(Form designed forum Drt elite(12-Pilch)typewriter.) Form Approved.CMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator M Number 2.Page 1 of 3.Emefgenoy Response Phone i, amt. hp M r <br /> WASTE MANIFEST � � r j6 (p 15371-A47 01 <br /> 154476 <br /> `]C JJ <br /> fi5.Ga.attRAirraptiamand Now ngyd�t�r��as Generators Site Address l' Ir id <br /> 1 U <br /> W I .L �r7�fwiV[w.? � <br /> 44.5 Lae r <br /> ;xw <br /> 4 JIT <br /> 6.Tsnsporter I Compahy Name RAMOS <br /> ENVIROFMENUIi.SERVICES <br /> KC. U.S.EPA ID l wr <br /> T Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and SiiaAddresVACFJC"MOURCS RECOVERY $,ET'A 90 t{rlrhtr <br /> 3150 EAX Pico&w.. <br /> LOS Ute.C OW <br /> Facpil <br /> Orono: <br /> 3a. 915.U.S.DOT Description(including Proper Shipping Name,Hazard Class,LD Number, 14.Containers 11.Total 12.Unit <br /> Hld and Packing Group(If any)) No. Typo Quantity WLNoL 13.Waste Codes <br /> at 0011 <br /> C.01Z,1"r .sP. $) CMCJ Ism nC) ._._ _. <br /> z z <br /> + <br /> Lu <br /> t� ( <br /> i <br /> i <br /> i <br /> 4. <br /> 14.Bpecia€Handling Instniations and Addltionat tPM <br /> n —^ <br /> I&M fIlm"EPAMOMM&SMUM <br /> 15. o .W,Iqt, ,;L, ' S CER74FICX'Citi#1 I hnre6ydes a ti sk gls cos a c'bks c rtsrg3ittsar#are�rly'arA frutd4lr d tisit l s by lt�.F DC[ irat e;air!�s rifled;pe k gep, <br /> rrr�% andhtb1aft!ac ;wilgrffOiailmaDne=labtpra arty]�asd'�rfransADracCcr�rtg�altptaneln�m�r�iu}rlrrar�xulGay�rn�utai.r$gn�tkne.rl��pas��1�p1?enttrndt�n,1�1?rlrrarrf <br /> E�cl1s�I caFltty glad Ihq goastarltr,4f Ir?la�f199rq:rpri[caofaml t4� -crfL'x allu;Xred`07Ar�cktt�faftt.aiCrnsanl.. <br /> 1 anti rhalifca rrrr71m;t311gtt Aiptnlr#u#idartirt 4�JR <br /> JY a)�fE�»tr�(arAo�'triml�4�)tat.am�sllidlsllyw4€duir}(>fwe. <br /> � a �pt3n�diTypaQ Nsma <br /> '�({1 W <br /> t Signature M01M Day Year <br /> f <br /> ...r 76.IniemalionalShipmenls - * {Q <br /> z ❑Import to U.S. ❑Export from U.S. Part of entryre7dt <br /> Transpodersignalure ror exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Prin#t pmd amn Signature Month Day Year <br /> Transporter 2 Pdntedllyped Name ; Signalure Mon6s Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Spa" ❑ Quantity ❑T e <br /> Yp ❑Res5due ❑Partial Rejecllon ❑Full Rejection <br /> ManKesl Reference Numbe <br /> 18h.Ntemale Facility(or Generator) r: U.S.EPA ID Number <br /> J <br /> U <br /> Facirlys Phone: <br /> LLI 16c.Signature ofAltemate Fadilly(or Generator) Month Day Year <br /> d <br /> z <br /> 19.Hezardaus Waste Report Management Method Codes(I.e.,codes for.hazardous;waste Imalmenl,disposal,and recyGing systems) <br /> LLJ1 <br /> lu� 3. ¢ <br /> 20.Dasignated Facility pwnw or Operator:Cmtlfltft.-.f receipt of hazardous materials covered by mardfest except as noted n Ilom 18a <br /> PrintedfTypad Name 519natura a Month Day Ya <br /> EPA Form 8700-22(Rev:3-05) Previous editions areobsolete. DESIGNA FACILnif 70 Ot-S71NAT ON STATE(IF€SQUIRED) <br />